Provider Demographics
NPI:1306091145
Name:COSTELLO STEVENS, MARY CATHERINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:COSTELLO STEVENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3890 S GLENCOE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1025
Mailing Address - Country:US
Mailing Address - Phone:512-507-6853
Mailing Address - Fax:303-770-6501
Practice Address - Street 1:7000 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1617
Practice Address - Country:US
Practice Address - Phone:303-380-7070
Practice Address - Fax:303-770-6501
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO5844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health